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allison - May 29th, 2008 9:04 AM

Dr. Jacobs

My husband and I are both 33. We have a 14yo daughter together.

We just completed our 3rd IVF. I respond well to stimulation and have always had sufficient eggs. The 1st IVF we did not do ICSI and ended up with terrible quality embryos with a lot of fragmentation, nothing that looked like a blast, but transferred 2 anyway. The 2nd IVF we did ICSI. Only half of my eggs fertilized and we ended up with 2 decent blasts, although slightly fragmented. No pregnancy, nothing to cryopreserve. We sent away my husband's sperm for the DNA testing and all looked OK. This time we did Estrogen-primed protocol with Gonal-F, Menopur and Lupron. I had 9 mature eggs, only 4 fertilized with ICSI. They were slightly fragmented on day 2 (but less than previous cycles), so my RE opted to do a day 2 transfer of all 4 embroys. I don't think this is done very often, but in your opinion, does this give us a better chance? What do you think?

B. Jacobs, M. D. - May 30th, 2008 6:33 AM

WE have not done a day 2 transfer. I am uncertain that the fragmentation problem withour ICSI would be correctable with ICSI. Without knowng the fate of other embryos in the lab, I cannot comment as to whether there may be a lab problem. Since there was already fragmantation on day 2, I question the hypothesis that it is a sperm problem. Genes from sperm do not play a role in embryo developement until after day 3.
Good luck.


allison - June 1st, 2008 10:26 AM

Thank you.

So, therefore do you think it is an egg problem? Or more likely a lab problem?

B. Jacobs, M. D. - June 3rd, 2008 6:38 AM

It may be either one. I have no way of determining. If other embryos werer doing well in the lab at the same time, the lab is probably OK.
Good luck.

B. Jacobs, M. D. - June 24th, 2008 4:51 PM

We do not do day 2 transfers, and I have no experrience with transfer that early, We rarely do day 3 tranfers, and do assisted hatching on those embryos. Usually we do day 5 tranfers, and do assisted hatching if the zona is still thick.
Good luck.

shmoopy - June 24th, 2008 6:01 PM

Thanks.

This cycle was cetrotide/FSH/repronex with no prior cycle suppression phase. Both clinics recommended foregoing the suppression phase in the belief that our underlying issue is probably embryo quality, and this approach tends to produce better results if that is the case.

Do you ever utilize that approach? If not, what would be your typical approach in a case like ours, given the background info. posted above? I realize you couldn't make any formal recommendation without the entire medical history, of course. But I would be interested in your general thoughts.

B. Jacobs, M. D. - June 25th, 2008 6:38 AM

We have not been pleased with pregnancy rates using Cetrotide. We use Lupron protocols.
Good luck.

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